What healthcare will look like in 2020 | Stephen Klasko | TEDxPhiladelphia

Transcript 00:00 Translator: TED Translators admin Reviewer: Queenie Lee 00:11 Well, I want to thank you all for coming, 00:13 and especially the people that came from outside of Philadelphia 00:16 that hovered over here; 00:18 especially those of you that time-traveled from other decades and times. 00:21 I’m Steve Klasko. 00:23 I’m the CEO

Transcript

00:00
Translator: TED Translators admin Reviewer: Queenie Lee
00:11
Well, I want to thank you all for coming,
00:13
and especially the people that came from outside of Philadelphia
00:16
that hovered over here;
00:18
especially those of you that time-traveled from other decades and times.
00:21
I’m Steve Klasko.
00:23
I’m the CEO of Stevie’s Vinyl Emporium and Implantable Health Chips
00:26
in South Street in Philadelphia.
00:28
(Laughter)
00:29
That’s what I am today.
00:30
But for the past ten years,
00:32
I’ve been the presidency of Thomas Jefferson University
00:35
in Jefferson University Hospital System
00:37
that literally was one of the pioneers along with several others
00:40
for what is now called the leaders of the optimistic future
00:44
in Healthcare Revolution from 2015 to 2024.
00:48
So for those of you who are coming from another decade,
00:50
or for those of you who are here in the 2020s,
00:52
I’d like to talk a little bit about how that journey happened
00:55
and maybe give you a little bit of the personal story
00:58
about how it happened for me.
00:59
So first one of the things that we did, is we got tired of whining,
01:02
and we decided let’s just travel to the future,
01:05
think about what we want and then create it.
01:07
For me, that started in 1977.
01:11
Very important time for me, I was a senior medical student.
01:14
It was important because I got asked to give a talk for TED.
01:17
Now not the TED you’re thinking of because TED didn’t exist in 1977.
01:21
It was called tomorrow’s education of doctors.
01:23
It was everything different than the technology that exists today.
01:26
It was a little slideshow with a screen,
01:29
but they asked me to talk about what the future of medicine looks like
01:32
from a medical student’s point of view.
01:34
I remember it for it was the first time I saw the Rolling Stones –
01:37
this is what they looked like back then; I was a huge fan.
01:40
But what I talked about because I was a little nervous about the first talk,
01:44
I talked about: Can you do anything about spiraling costs?
01:46
Can you change the fee-for-service system,
01:49
so we’re really rewarding value and not volume?
01:52
And can you measure outcomes?
01:54
And I said my generation of docs is going to solve this over the next four years.
01:58
We are not going to be dealing with this even 20 years from now.
02:03
Well, amazingly the docs said, “No.”
02:06
And that didn’t happen.
02:07
Now I was also a very different person back in 1977.
02:10
This is what I look like.
02:11
(Applause) (Cheering)
02:14
Thank you.
02:18
That’s called a leisure suit.
02:20
(Laughter)
02:23
But for a brief interlude where they tried to bring it back in 2019,
02:27
I think it’s safe to say it’s out of the fashion lexicon forever,
02:31
but the car was in 1968 GTO which was and is a very cool car.
02:36
Thank you.
02:37
So then we went through really what some people called
02:40
the middle or dark ages,
02:41
the Managed Care Revolution, which did not really manage anything.
02:45
It didn’t really provide care; it just promoted underutilization –
02:48
the balanced budget amendment,
02:50
which didn’t balance the budget, and didn’t really amend anything.
02:53
And then the first iteration of what has now been 17 iterations
02:56
of what was then called Obamacare.
02:58
So that brings us to 2014, and why was 2014 important to me?
03:02
Well, I was very proud and honored to be inaugurated and selected
03:05
as the first president and CEO
03:07
of Thomas Jefferson University and Health System combined.
03:11
It was also a big moment for me because it was the second time I saw them.
03:14
This is what the Rolling Stones looked like back in 2014.
03:17
(Laughter)
03:18
And in my inauguration I was given a script,
03:21
and what I talked about my inauguration in 2014 is:
03:23
“Hey, can we do anything about spiraling costs?”
03:25
Can we change the fee-for-service?
03:27
Do you think we can measure outcomes?
03:29
That was a bit of an a-ha moment for me,
03:31
I said, “Well, 37 years, that’s a lot for not to have much change.”
03:35
This time though, the insurers and government said:
03:38
“We’re really going to do it.”
03:40
And really what people were actually predicting is –
03:43
because believe it or not, even at 2014
03:46
the docs said: “I really don’t want to take any risks.
03:49
I think things are fine the way they were.”
03:51
And you couldn’t go a week without people
03:54
threatening the extinction of academic health centers.
03:57
So I’m proud to say here in Philadelphia and at Jefferson we said yes,
04:01
and I’d love to talk to you a little bit about what happened between 2014 and 2024.
04:06
So here we are in 2024, and by the way,
04:08
I don’t know if any of you saw it on your Facebook implantable glasses,
04:13
the Zombie Rock Tour, it was awesome.
04:16
It was awesome.
04:17
By the way, those Facebook implantable glasses
04:20
can be bought at Stevie’s Vinyl Records and Implantable Devices.
04:23
(Laughter)
04:25
I thought the Rolling Stones, the Rolling Stones rocked,
04:29
(Laughter) (Cheers)
04:30
they rocked the undead tour, right?
04:32
Who agrees with me? They rocked the undead tour.
04:34
Seven decades of great Rolling Stones.
04:37
You talk about not getting any satisfaction,
04:39
look at these guys.
04:40
(Laughter)
04:42
But more importantly, more importantly,
04:44
what happened in Philadelphia, what happened at Jefferson was,
04:48
that we took that mode of saying –
04:50
people said that it’s impossible to change healthcare.
04:53
And really the personal piece, for me believe it or not,
04:56
didn’t come from Maimonides or Aristotle,
04:58
or even somebody from the University of Pennsylvania or Jefferson.
05:01
It came from a sneaker commercial.
05:03
It was an Adidas marketing campaign back in 2014 called the Impossible.
05:07
It said “impossible” is just a big word thrown around by small men and women
05:11
who find it easier to live the world they’ve been given
05:14
rather than explore the power they have to change it.
05:17
Impossible is not a fact; it’s an opinion.
05:19
Impossible is temporary; impossible is nothing.
05:22
So we decided, “What the heck, let’s do the impossible.”
05:25
Because everybody knew things were changing,
05:27
we weren’t going to wait for a miracle.
05:30
And we said, “Let’s do it.”
05:32
OK, so here it is, it’s March 28th, 2024.
05:34
Now I apologize for those of you who come from this decade,
05:37
but I know some of you probably have time travel lag,
05:40
and I just want you to know where we’re at today.
05:42
So it’s March 28th, 2024,
05:43
President Jenna Bush will be debating Democratic nominee Chelsea Clinton,
05:47
in what a lot of people think will be a very tight race.
05:50
Harrison Ford has signed up for one last Indiana Jones sequel,
05:53
(Laughter)
05:54
tentatively titled Indiana Jones: the Legend of Bingo Night,
05:57
we’re all excited about that one.
05:59
And the Eagles are 2-0 and trying to win their first Super Bowl
06:02
since the unprecedented fourth straight they won from 2015 to 2018,
06:05
the so-called Chip Championship Years.
06:08
(Applause) (Cheering)
06:11
Of course, Governor Chip now has a very different job than he had back then.
06:16
But more importantly or as importantly,
06:18
Jefferson is celebrating its 200th anniversary
06:21
as an international hub of innovation,
06:24
with headquarters in Philadelphia,
06:26
instead of just the Philadelphia academic medical center.
06:28
We’ve become a destination site for innovative entrepreneurial health
06:32
with unprecedented economic development,
06:34
and our creative partnerships
06:35
have allowed us to become what The Wall Street Journal called
06:38
a thriving cluster on the verge of a chain reaction,
06:41
which has helped make Philadelphia the epicenter of the new healthcare.
06:44
By the way, I’m getting out of my DeLorean
06:46
to accept an award from the US News and Interplanetary Report.
06:50
As most of you know in 2019, we found two other planets
06:53
with slightly dysfunctional health systems,
06:55
so they are now part of the ranking system that the former USNWR used.
06:59
So how did we get there? I’d like to …
07:02
TEDx has asked me to talk about three things that we did
07:05
that were very different.
07:07
First of all, we decided that we’re going to start to create docs of the future,
07:11
that it’s ridiculous to have the same way that we selected and educated physicians
07:16
that became autonomous, competitive, and hierarchical,
07:19
and that we actually were going to change the DNA of healthcare
07:22
literally one physician at a time.
07:23
You may not believe this,
07:25
but back in 2014, we still chose doctors based on science GPAs, MedCaTs,
07:30
which were a multiple-choice test, and organic chemistry performance.
07:34
And somehow we were amazed that doctors weren’t more empathetic,
07:37
communicative, and creative.
07:38
As my kids would say, “Duh.”
07:40
(Laughter) (Applause)
07:42
So we changed all that.
07:43
What we recognized is that it used to be for those of you who came from the ’70s –
07:48
and I think there are actually some,
07:51
I see some people from 2014, I see some people from the ’80s.
07:54
Go Journey, yeah.
07:56
(Laughter)
07:57
I see some tie-dye out there, some ’60s and ’70s. Peace!
08:01
But we decided to transform admissions.
08:05
What we realized is that all the scientific data
08:08
is on what in 2014 we called iPhones and Androids,
08:12
but really what we needed were emotionally intelligent physicians.
08:15
So we now really select physicians based on self-awareness, self-management,
08:20
and the ability to adapt, social awareness and empathy,
08:23
relationship management, teamwork,
08:25
and the ability to really embrace change instead of fighting it.
08:29
But not only that,
08:30
we totally changed the way that we teach the physicians that we do accept.
08:34
Believe it or not back in 2014,
08:36
we used to spend two years really teaching them scientific principles
08:40
in large auditoriums, classes that a lot of them didn’t come to,
08:43
when we recognized that we could do all that,
08:46
have them learn that at two o’clock in the morning.
08:48
Now we spend most of our time in what we call the Art of Attending.
08:51
Teaching them to really observe, we started back in 2014,
08:55
workshops designed to sharpen observation skills of health students
08:59
by looking at art.
09:00
Very unusual partnership,
09:02
it was Thomas Jefferson University, Contemporary Art Museum,
09:06
an institute for an optimistic future in healthcare.
09:08
We took students and had them understand art.
09:12
So if you take this piece of art over here,
09:14
medical students originally said,
09:16
“Well, that’s a woman; that’s a snake; that’s a family.”
09:19
But when you started to look and say, “What is the story?”,
09:22
it started to totally change the way that they cared for patients.
09:26
And at the end of the day, we went from silos of full-time individuals
09:30
to folks who could deliver team-enabled and team-based care.
09:34
Doctors went from being captains of the ship to being part of a team,
09:37
and they, believe it or not, work closely
09:39
with multidisciplinary care-delivery teams,
09:42
including doctors of nursing practice, nurse practitioners,
09:45
clinical pharmacists, physician’s assistants.
09:47
and at the Thomas Jefferson Institute of Emerging Health Professions,
09:50
professions that didn’t even exist in 2014,
09:53
things like probability experts, electronic health care ambassadors,
09:58
and telehealth professionals.
10:00
So we recognized that we needed to evolve doctoring.
10:04
We also recognized that the patient experience was really pretty lousy.
10:09
Back in 2014, you could actually do anything you needed to do in travel,
10:14
anything you needed to do in shopping on a device,
10:17
but could you get an appointment with a physician? No.
10:20
Could you interact with a doctor or nurse? No.
10:23
So we decided that healthcare needed in 2014 to get into the E&I; mode.
10:27
If you even look at how people viewed us from TV shows –
10:32
how many of you are here from the ’70s? There you go, okay.
10:35
So the big tip television show in the ’70s was Marcus Welby.
10:38
Now here’s what Marcus Welby was.
10:40
He was a family physician.
10:41
He would get up in the morning,
10:43
he would go to the homeless shelter, take care of people for free.
10:46
On the way home to lunch, a cow would be having trouble delivering a calf,
10:50
he’d deliver it.
10:51
He’d then go to his family medicine office in the afternoon,
10:54
and then at night he’d do left ventricular neurosurgery.
10:57
We were Gods, we could do everything, that’s how people viewed us.
11:00
In the 2010s this is what we had. Anybody remember this guy?
11:03
(Laughter)
11:05
He was a drug-addicted, sex-addicted, really smart guy
11:09
that couldn’t communicate or see patients.
11:12
That’s what people viewed us.
11:14
The number one TV show of 2023?
11:17
Was Doctor WHO, which stands for Watson Hybrid Organo Doc,
11:23
who basically fell in love with his robotic-bionic counterpart
11:28
who does all the scientific stuff while he does the emotional stuff.
11:31
And as you can imagine, hilarity ensues.
11:33
By the way …
11:35
(Laughter)
11:36
By the way the first season of Doctor WHO
11:41
is available on Google Glass implantable chips,
11:45
available at Stevie’s Vinyl Records and Implantable Chips on South Street.
11:50
(Laughter)
11:51
So the other thing we embraced was entrepreneurship.
11:54
We recognized that being academic and entrepreneurial
11:57
just were not mutually exclusive,
11:59
and we also recognized that we had to enhance the consumer experience.
12:03
It really was lousy going to a physician.
12:06
This is what it looked like back in 2014.
12:08
Female: What’s wrong? Stevenson: I don’t feel so good.
12:11
F: Then you need to go to a doctor.
12:20
Female nurse: Mr. Stephenson? S: Stevenson.
12:24
FN: Do you have any allergies?
12:25
How would you describe your symptoms? What is the general area of pain?
12:29
Does your family have a history of heart disease or diabetes?
12:32
Doctor: And what seems to be the problem today, Mr. Stevenson?
12:36
S: I’m feeling a little stuffed up. I’m experiencing some …
12:39
FN: Doctor, your 3 o’clock is early, your 2:45 is late from 6 and 7.
12:42
D: Follow these instructions;
12:44
if it doesn’t clear up in a week or two, come back; we’ll do this all over again.
12:48
(Moaning)
12:50
S: I don’t like going to a doctor.
12:52
SK: So in July of 2014, we partnered with some great companies,
12:56
created an innovation-driven ecosystem for healthcare.
13:00
Starting in 2015, patients in 48 states
13:02
could access Jefferson doctors via telemedicine.
13:05
S: Well, now you can see a doctor without going to a doctor’s office
13:08
with the help of your smartphone, or computer, and American Well.
13:11
Signing up and setting up your health profile is easy;
13:14
it only takes a minute,
13:15
and once you’ve done it, it’s stored safely and securely.
13:18
Then you can log in or use the App to see doctors who’re available,
13:21
and connect by video phone or chat.
13:25
D: Hi Allen.
13:26
I see you’ve been experiencing some congestion and some nasal blockage.
13:30
How long has this been going on?
13:32
S: During the visit, the doctor can see your health information,
13:35
afterward, you get a complete write-up of everything the doctor says.
13:38
D: It looks like acute sinusitis, a sinus infection.
13:41
Now I wrote you a prescription to help with congestion.
13:44
If things don’t clear up in, say, a week or so,
13:46
just send me a message, I’ll be right here.
13:49
S: A few mins later, I’ve got my diagnosis and my instructions for treatment
13:53
and my prescription is already waiting for me at the pharmacy.
13:56
SK: Of course, all that now happens in your Google Glasses
13:59
which are available by the way
14:01
at Stevie’s Vinyl Records and Implantable Health Chips.
14:05
We also recognized that information was everything.
14:09
As Yogi Berra would say, it comes down to one word, big data.
14:13
And believe it or not, believe it or not,
14:16
we used to do everything based on experience and anecdote.
14:19
Evidence-based medicine in 2014 was actually a novel idea.
14:24
And now we recognize that we can take things from other industries.
14:28
So at Jefferson, for example, in 2014, we started
14:31
the Center for Healthcare, Entrepreneurship and Scientific Solutions.
14:34
We said, “It really doesn’t make any sense that Nick Foles has a better idea
14:40
of whether or not a screen pass will work in the third quarter
14:43
than I do of whether or not a cancer drug will work.”
14:46
So we took some of the best people doing mathematical modeling
14:49
and created a predictive analytics and mathematical modeling
14:52
to reduce uncertainty in medicine.
14:54
Believe it or not, in 2014, 28% of people that went to the hospital in this country
14:59
got readmitted within 90 days.
15:02
Now, through our mathematical modeling
15:04
we’re able to see exactly what intervention
15:06
will keep people from coming back.
15:08
Not only that, we’ve changed the way we do things.
15:10
In 2014, family medicine physicians would actually be out of the hospital.
15:15
Hospitalists would never leave the hospital,
15:17
and then there was no real communication.
15:20
Now we have what’s called extensiveness,
15:22
hospitalists that actually follow those patients for 90 days
15:25
so they don’t get readmitted.
15:27
We actually pay for performance now
15:29
because we can actually measure performance.
15:31
And we can actually give you predictable answers
15:35
as to what you’re paying for and what you’re getting back.
15:37
Accountable care organizations for the first time really are accountable
15:41
because we have math to back it up.
15:44
One of the great things that happened in Philadelphia,
15:46
believe it or not, again in 2014,
15:49
with decreasing NIH funding,
15:51
Penn, Jefferson, Temple, Drexel, would all fight for NIH funds.
15:57
What we did, and one of the greatest things we did,
15:59
we created the Philadelphia Clinical Research Super Site
16:02
where we said really what’s important is to take all of our resources,
16:06
both in education and research, and make Philadelphia an epicenter.
16:09
What did that do for us over the last ten years?
16:11
We were able to take the Nanotechnology University of Pennsylvania
16:15
and Molecular Genomics at Jefferson
16:17
and create the DNA vending machine.
16:19
For those of you from the 2010s, it’s sort of like a red box for your DNA.
16:23
We can now pick a drug for you,
16:25
and instead of saying it’s for 200 people that look like you,
16:28
we can take exactly the drug that fits your genome
16:31
and have it available for you.
16:33
We can also put your genome on a chip,
16:35
so that God forbid,
16:36
if you need a new organ, we can make that for you
16:39
based on work that’s been done in Philadelphia.
16:41
And we finally decided to work with patients
16:44
to really make them shareholders in their health,
16:47
and this is what it means.
16:48
It means that in a community like Philadelphia,
16:51
if we’re able to make you healthier,
16:53
we do better as physicians; you do better.
16:56
And we actually partnered with great companies
16:58
from again outside Philadelphia
17:00
to look at a different way of making sure that everyone matters,
17:04
that we can look at not only drugs, but holistic remedies
17:08
to look at personalized performance-gain plans
17:11
integrating a proven system to drive health outcomes.
17:14
Whether it’s mindset, or nutrition, or movement, or recovery,
17:18
we were able to do many more things that didn’t require pharmaceuticals.
17:22
So that brings us to 2024, and as I said,
17:25
I’m here to accept our number one ranking from the US News and Interplanetary Report
17:31
and what’s really cool is
17:32
that some of the ranking parameters didn’t even exist in 2014,
17:35
and I’ll give you an example of a few of them on the academic side
17:38
and also on the clinical side.
17:40
On the academic side, we actually, imagine this,
17:43
get ranked based on how our students do at one year, three year, or five year.
17:48
We measure individuals’ professional and personal happiness
17:51
at varying intervals after graduation.
17:53
Because after all, that’s why they came to our university.
17:56
And if we don’t do really well,
17:58
then they actually get some of their money back.
18:00
We have a collaborative quotient.
18:02
Academic entities are incentivized to actually get over themselves
18:05
and work well with others,
18:07
(Laughter) (Applause)
18:09
which would have been unheard of in 2014
18:11
when they were all cannibalizing each other.
18:13
And we have an entrepreneurial quotient where institutions are rewarded
18:17
that invent and envision new ways of doing things
18:20
that generate alternate revenue and develop new student opportunities.
18:23
But probably nothing’s changed the most than health quotients.
18:28
I mean, it used to be back in 2014 and before
18:31
that parameters were based on the reputational score in the past.
18:34
Now it’s based on what patients think.
18:36
The one I’m really proud of that we got a very high score on
18:39
is called the BUB Quotient.
18:41
It stands for the Believable Understandable Bill,
18:43
that we actually have enough respect for patients
18:46
that we provide understandable bills,
18:48
so they can understand what they got and what they’re paying for.
18:52
We have the say-what-you-mean and mean-what-you-say quality parameter.
18:55
We actually take marketing professionals to read all the billboards
18:58
in the marketing we do,
18:59
and see if they have any semblance to reality of what really happens
19:03
in the hospital,
19:03
and you get points if there is some semblance to reality.
19:06
And then finally we have the through-the-patient-eyes factor.
19:09
And this is really exciting because what it is,
19:12
is every patient now, in 2024,
19:14
basically when they get in the hospital is given a Google Glasses,
19:18
and they basically can record what’s happening through their eyes,
19:22
how the doctors and nurses are treating them,
19:25
and then we have CEOs of other hospitals look at that video for a day
19:28
and grade on 1 to 10 whether they’d like to spend a day in that hospital.
19:32
And again that’s a great parameter for us.
19:35
So a lot has happened since 2024,
19:37
and I’m really excited to be here.
19:40
We’re about to accept an award in the new Convention Center & Casino
19:43
on the Schuylkill River.
19:44
(Laughter)
19:46
And some things from the past really are good.
19:49
I’m going through my third midlife crisis
19:52
because I’m 70 and what happens is people live to 120,
19:56
so midlife crises have changed.
19:58
And I’m proud to say this is what I got myself,
20:00
I was able to retrofit a GTO to hit the standards for a hovercraft.
20:05
Excuse me for a second, Google Glass out, could you get the GTO to get ready
20:09
to go to the Convention Center? Great. Thank you.
20:12
Listen, I want to really thank you for being here,
20:14
I want to thank you for traveling in time and space,
20:16
and most importantly, stay healthy in Philadelphia.
20:19
Thank you very much.
20:20
(Applause) (Cheering)
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